Online video games and patient–staff power relations. A qualitative study of care and custody in forensic psychiatry

Terkildsen, Morten Deleuran; Kennedy, Harry G; Jentz, Christian; Sørensen, Lambert K.

doi:10.1111/jpm.12813

Cited by 8 publications

(8 citation statements)

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“…Having arranged our data in meaningful groups, we started identifying themes. At this stage, we found a strong resonance between our codes, our initial themes, and a theoretical framework (Terkildsen et al, 2021). Departing in Jarett Zigon's theoretical framework of “moral breakdowns,” we identified one overarching theme; nurses' ethical demands during a pandemic (Zigon, 2007).…”

Section: Methodsmentioning

confidence: 75%

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COVID‐19 as moral breakdown: Entangled ethical demands experienced by hospital‐based nurses in the early onset of the pandemic

et al. 2022

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2020 saw the rapid onset of a global pandemic caused by the SARS‐CoV‐2 virus. For healthcare systems worldwide, the pandemic called upon quick organization ensuring treatment and containment measures for the new virus disease. Nurses were seen as constituting a vital instrumental professional component in this study. Due to the pandemic's unpredictable and potentially dangerous nature, nurses have faced unprecedented risks and challenges. Based on interviews and free text comment from a survey, this study explores how ethical challenges related to “being a nurse” during the COVID‐19 pandemic was experienced and understood by Danish hospital‐based nurses. Departing from anthropologist Jarett Zigon's notion of moral breakdown, the study demonstrates how the rapid onset of the pandemic constitutes a moral breakdown raising ethical demands for nurses. Analytically we identify three different ethical demands experienced by the nurses. These ethical demands are Nursing and societal ethical demands, Nursing and personal ethical demands , and Nursing and conflicting ethical demands . These demands represent not only very different understandings of ethical demands but also different understandings of ethical acts that are seen as necessary to respond to these demands.

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Section: Methodsmentioning

confidence: 75%

Section: Analysis Processmentioning

confidence: 84%

COVID‐19 as moral breakdown: Entangled ethical demands experienced by hospital‐based nurses in the early onset of the pandemic

et al. 2022

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“…Current forensic mental health research underlines a need to study how to balance care and custody in forensic mental health practices in ways where the promotion and sustainment of strong care relations are realized while risks posed by patients are managed accordingly (Mann et al., 2014; Terkildsen, Kennedy, et al., 2022; Terkildsen, Vestergaard, et al., 2022).…”

Section: Rationalementioning

confidence: 99%

“…For nurses working in recovery‐orientated secure settings, however, the use of explicit power (in the form of risk management strategies) has been depicted in literature as providing nurses with a role marred by a specific ambivalence (Martin & Street, 2003; Terkildsen, Kennedy, et al., 2022; Terkildsen, Vestergaard, et al., 2022). On the one hand, they are to engage patients in rehabilitative practices.…”

Section: Rationalementioning

confidence: 99%

Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study

Shetty,

Burke,

Timmons

et al. 2023

Psychiatric Ment Health Nurs

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Accessible SummaryWhat is known on the subject? Nurses‘ observation of patients in seclusion is essential to ensure patient safety. Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy. Direct observation and video monitoring are widely used in observing patients in seclusion. Coercive practices may cause distress to patient‐staff relations. What the paper adds to existing knowledge? We add detailed information on specific observation methods in seclusion and compare them from the perspective of patients. Nurses communicating with patients ensures relational contact and that quality care is provided to patients even in the most distressed phase of their illness. Providing prior information to patients on observation methods in seclusion and the need for engaging patients in meaningful activities, while in seclusion are emphasized. Observation via camera and nurses‘ presence near the seclusion room made patients feel safe and gave a sense of being cared for in seclusion. Pixellating the video camera would give a sense of privacy and dignity. What are the implications for practice? The overarching goal is to prevent seclusion. However, when seclusion is used as a last resort to manage risk to others, it should be done in ways that recognize the human rights of the patient, in ways that are least harmful, and in ways that recognize and cater to patients‘ unique needs. A consistent approach to relational contact and communication is essential. A care plan must include patient‘s preferred approach for interacting while in seclusion to support individualized care provision. Viewing panels (small window on the seclusion door) are important in establishing two‐way communication with the patient. Educating nurses to utilize them correctly helps stimulate relational contact and communication during seclusion to benefit patients. Engaging patients in meaningful activities when in seclusion is essential to keep them connected to the outside world. Depending on the patient‘s presentation in the seclusion room and their preferences for interactions, reading newspapers, poems, stories, or a book chapter aloud to patients, via the viewing panel could help ensure such connectedness. More focus should be placed on providing communication training to nurses to strengthen their communication skills in caring for individuals in challenging care situations. Patient education is paramount. Providing prior information to patients using a co‐produced information leaflet might reduce their anxiety and make them feel safe in the room. When using cameras in the seclusion room, these should be pixelated to maintain patients‘ privacy. AbstractIntroductionA lack of research investigating the specific role that various observational techniques may have in shaping the therapeutic relations in mental health care during seclusion warranted this study.AimThe aim of the study was to explore patients’ experience of different methods of observation used while the patient was in seclusion.MethodA retrospective phenomenological approach, using semi‐structured interviews, ten patients’ experiences of being observed in the seclusion room was investigated. Colaizzi’s descriptive phenomenological method was followed to analyse the data.ResultsCommunicating and engaging patients in meaningful activities can be achieved via the viewing panel. The camera was considered essential in monitoring behaviour and promoting a sense of safety. Pixelating the camera may transform patient view on privacy in seclusion.DiscussionThe mental health services must strive to prevent seclusion and every effort should be made to recognise the human rights of the patient. The study reveals numerous advantages when nurses actively engage in patient communication during the process of observation.Implications for PracticeDifferent observation methods yield different benefits; therefore, staff education in using these methods is paramount. Empowering the patient with prior information on seclusion, engaging them in meaningful activities and proper documentation on patient engagement, supports the provision of individualised care in seclusion.

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“…It is widely agreed that RPs should be minimised as patients report primarily adverse effects of being subjected to such measures [ 2 ]. RPs have been found to cause physical and psychological harm [ 3 ], lead to violence, and damage the therapeutic alliance, widely acknowledged as essential to achieving patient recovery [ 4 , 5 ]. Conversely, violence prevention in psychiatric wards is essential to maintain a therapeutically safe environment and protect other patients and staff [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Do improved structural surroundings reduce restrictive practices in psychiatry?

Harpøth

Kennedy

Terkildsen

et al. 2022

Int J Ment Health Syst

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Background and objectives There is sparse evidence that modern hospital architecture designed to prevent violence and self-harm can prevent restrictive practices (RP). We examine if the use of RPs was reduced by the structural change of relocating a 170-year-old psychiatric university hospital (UH) in Central Denmark Region (CDR) to a new modern purpose-built university hospital. Methods The dataset includes all admissions (N = 19.567) and RPs (N = 13.965) in the self-contained CDR one year before and after the relocation of the UH. We compare RPs at the UH a year prior to and after relocation on November 16th (November 2017, November 2019) with RPs at the other psychiatric hospitals (RH) in CDR. We applied linear regression analysis to assess the development in the monthly frequency of RPs pre- and post-relocation and examine underlying trends. Results At UH, RPs performed decreased from 4073 to 2585 after relocation, whereas they remained stable (from 3676 to 3631) at RH. Mechanical restraint and involuntary acute medication were aligned at both UH and RH. Using linear regression analysis, we found an overall significant decrease in the use of all restrictive practices at UH with an inclination of -9.1 observations (95% CI − 12.0; − 6.3 p < 0.0001) per month throughout the two-year follow-up. However, the decrease did not deviate significantly from the already downward trend observed one year before relocation. Similar analyses performed for RH showed a stable use of coercion. Conclusion The naturalistic features of the design preclude any definitive conclusion whether relocation to a new purpose-built psychiatric hospital decreased the RPs. However, we argue that improving the structural environment at the UH had a sustained effect on the already declining use of RPs, particularly mechanical restraint and involuntary acute medication.

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Online video games and patient–staff power relations. A qualitative study of care and custody in forensic psychiatry

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 8 publications

References 44 publications

COVID‐19 as moral breakdown: Entangled ethical demands experienced by hospital‐based nurses in the early onset of the pandemic

COVID‐19 as moral breakdown: Entangled ethical demands experienced by hospital‐based nurses in the early onset of the pandemic

Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study

Do improved structural surroundings reduce restrictive practices in psychiatry?

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